UW DERMATOLOGY RESIDENT QI COURSE

Integrate quality improvement concepts and activities in practice Assessing how residents are engaged in the use of data to improve systems of care, reduce health care disparities and improve patient outcomes CLER assesses sponsoring institutions in the following six focus areas: Patient Safety – including opportunities for residents to report errors, unsafe conditions, and near misses, and to participate in inter-professional teams to promote and enhance safe care. Quality Improvement – including how sponsoring institutions engage residents in the use of data to improve systems of care, reduce health care disparities and improve patient outcomes. Transitions in Care – including how sponsoring institutions demonstrate effective standardization and oversight of transitions of care. Supervision – including how sponsoring institutions maintain and oversee policies of supervision concordant with ACGME requirements in an environment at both the institutional and program level that assures the absence of retribution. Duty Hours Oversight, Fatigue Management and Mitigation – including how sponsoring institutions: (i) demonstrate effective and meaningful oversight of duty hours across all residency programs institution-wide; (ii) design systems and provide settings that facilitate fatigue management and mitigation; and (iii) provide effective education of faculty members and residents in sleep, fatigue recognition, and fatigue mitigation. Professionalism—with regard to how sponsoring institutions educate for professionalism, monitor behavior on the part of residents and faculty and respond to issues concerning: (i) accurate reporting of program information; (ii) integrity in fulfilling educational and professional responsibilities; and (iii) veracity in scholarly pursuits. From IHI “Residency training in the US has long had the reputation of a rite of passage — a period when grueling hours on busy hospital floors are spent converting four years of medical school, and some clinical exposure, into real-time accountability for real patients who have sometimes serious and life-threatening medical conditions. However, a changing health care system now demands that residents develop the skills not just to diagnose and treat patients who are ill, but to protect them from harm and to reduce their chances of being readmitted. Residents need to know about managing chronic conditions and how to help patients lead healthier lives. These new goals present newly-minted MDs, and those who train them, with new challenges — among them, the need to work in teams and communicate with everyone, including patients and families, more effectively; the need to sleep after long hours on the job and to honor the requirement to take the time (and time off) to do so; the need to engage in effective handoffs to other providers and to help coordinate care across multiple health care settings. It’s a tall order for the nation’s complex system of training doctors, and aligning what happens in residency programs with the ambitions of quality improvement is at an early stage. Why is this the case? What can be done to accelerate reforms? Where are promising new models starting to emerge” Milestone PBLI3. Integrate quality improvement concepts and activities in practice

LEAN methodology: Structured problem solving Lean thinking concepts:Defining "value" from a customer and patient perspective Identifying "waste" and non-value-added activity Identifying and improving "value-streams" Creating better "flow" for patients and processes Preventing errors and improving quality in a systematic way Creating an environment of true "kaizen" (continuous improvement)

PDCA Cycle & Improvement Steps

Quality Improvement Project A3 Title of QI Project: Team Members: Project Mentor(s): Start Date: Revision date: Quality Improvement Project A3 Patient Population (if appl.): Physicians Participating (if appl.): Institute of Medicine Quality Dimensions addressed: Background Recommendations What are you talking about and why? What is the purpose, the business or clinical reason for choosing this problem to work on? What specific performance measures need to be improved? What do you propose and why? What are the options for addressing the gaps and improving performance in the current situation? How do they compare in effectiveness, feasibility, and potential disruption? What are the their relative costs and benefits? Current Situation Problem Statement: What is the current process? What data and facts indicate there is a problem? What is happening now versus what should or needs to be happening? What specific conditions indicate there is a problem or need? Where and how much? Show facts and processes visually using maps, charts, graphs, etc. Plan How will the selected recommendation be implemented? What will be the main actions and outcomes in the implementation process? What support and resources will be required? Who will be responsible for what, when, and how much? How will effectiveness be measured? When will progress be reviewed and by whom? Consider using a Gantt chart or similar diagram to display actions, steps, outcomes, timelines, roles. Problem Statement: One clear and precise sentence summarizing the gap to be addressed. Goal What specific outcome is required? What specific improvement(s) in performance needs to be achieved? By how much and when? Analysis Why does the problem or need exist? What do the specifics of the issues in work processes (location, patterns, trends, factors) indicate about why the performance gap or need exists? Show the cause-and-effect and root cause. Show the logic flow of how addressing root causes will address performance gaps. Consider tools such as 5-Whys, Fishbone diagrams, pareto charts, or other problem analysis tools. Follow-up How and when will it be known if plans have been followed and the actions taken had the anticipated impact? How will effectiveness be measured? When will progress be reviewed and by whom? How will learnings be shared? .

Course Structure Resident teams of 3 First Thursdays Meeting Guided project work Review LEAN concepts/tools Out of class teamwork Final Presentation to Division in June

People Project Selection Resident initiated Small scope One PDCA cycle Resident teams Course director (me ) Faculty mentors

Resident Projects UW Roosevelt Biopsy Photos April Schachtel, Erica Tarabadkar, Katie DeNiro Optimizing Safety and Efficiency of Patient Follow-up at the Veterans Administration (VA) Hospital and Clinics Cait May, Kate Khorsand, Vanessa Pascoe Improving the quality of patient instructions at the VA Shelley Yang, Jayasri Iyer, Maryam Safaee